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The Straining Infant
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Red flags vs functional constipation vs infant dyschezia.
Decision
Outcome
Decision
Infant straining with stools. First triage?
✓
Ill-appearing or red flags (distention, abnormal rectal tone, delayed meconium, FTT)
✓
Well-appearing
Outcome
Serious organic cause workup: Hirschsprung, cystic fibrosis, spinal dysraphism, hypothyroidism
Decision
Stool characteristics?
✓
Loose stools, mucus, blood → food protein-induced proctocolitis
✓
Normal stool consistency → infant dyschezia
✓
Hard or pellet-like stools → functional constipation
Outcome
Eliminate cow milk protein (and soy if breastfeeding) or switch to hypoallergenic formula
Outcome
Normal infant dyschezia; reassurance — resolves spontaneously
Outcome
Functional constipation; consider anal fissure if blood streaked
Increase fluid; for ≥6 months, may add prune juice or PEG.
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